Early childhood intervention describes the services and supports available to at-risk families and children. Attachment and Biobehavioral Catch-up (ABC), a 10-session early childhood intervention, is delivered in-home to a parent or other caregiver of children aged 6 to 24 months at-risk for early adversity. The strength of parent–child attachment, as described by Ainsworth (1979), is connected to the accessibility and responsiveness of the mother to the child; this is referred to as parental sensitivity. Model purveyors of ABC (Bernard et al., 2013) build upon this multi-dimensional construct by distinguishing sensitivity to children’s distress cues (nurturance) from non-distress cues (synchrony) and target three main areas: (1) caregiver learns to provide nurturance regardless of their child’s behavior (e.g., caregiver responds in caring manner even though child pushes them away); (2) caregiver learns to help child develop regulatory capabilities; and, (3) caregiver learns to decrease behaviors that may frighten or overwhelm their child (Meade et al., 2014). By focusing on parental sensitivity, the ABC intervention helps children exposed to or at-risk of early childhood adversity to develop stronger attachments and emotion regulation skills thereby reducing the impacts of toxic stress (Bernard et al., 2012).

ABC has undergone multiple randomized clinical trials (RCT) with child welfare-involved children and families, foster parents, and parents adopting internationally (Bernard et al., 2012, 2015; Dozier et al., 2008, 2009; Lind et al., 2014, 2017; Raby et al., 2018; Sprang, 2009; Yarger et al. 2016). Results from RCTs indicate significantly lower cortisol levels in children who received the ABC intervention than those who did not (Dozier et al., 2008). In another study, children who received the ABC intervention showed higher rates of secure attachment than those in the control group (Bernard et al., 2012). Most RCTs have been conducted in the mid-Atlantic region of the United States (U.S.) among African American or white, non-Hispanic children and families (Grube & Liming, 2018).

Recognizing that EBIs can lose their effectiveness when transitioning from controlled to community settings, maintaining fidelity during delivery of the intervention is important to ensuring consistency of outcomes between settings (Dusenbury et al., 2003; Roben et al., 2017). To maintain fidelity, ABC is a highly manualized intervention. There is much debate about whether EBIs should adhere to strict fidelity protocols or if cultural adaptations are needed when delivered among diverse community contexts (Castro et al., 2010; Miranda et al., 2005). Intervention work, particularly in the U.S., has demonstrated efforts to engage cultural minority groups for decades although the manner in which these efforts have been undertaken is not well documented or understood (Knerr et al., 2013).

Cultural Adaptation

Cultural adaptation is defined as the “systematic modification of an evidence-based treatment or intervention protocol to consider language, culture, and contexts in such a way that it is compatible with the client’s cultural patterns, meanings, and values” (Bernal et al., 2009, p. 362). Adaptations can occur at one of two levels: surface and deep-structures. Resnicow et al. (2000) and Hiratsuka et al. (2018) argue that surface-level adaptations constitute changes made to activities or materials to reflect observable, superficial characteristics of a particular community or population. Deep-structure adaptations, however, involve changes that incorporate social, cultural, geographical, or historical factors that influence the life and experiences of a target population (Hiratsuka et al., 2018; Mejia et al., 2016; Resnicow et al., 2000). Conversations around cultural adaptation generally involve surface-level changes and, while an important first step, miss opportunities for understanding the cultural, social, and environmental contexts in which ethnocultural groups live and work (Alegria et al., 2010). For the purposes of this discussion, ethnocultural refers to communities or groups of individuals who share qualities and characteristics unique to that community or group. Shared characteristics may include cultural heritage, values, and traditions, language or dialects, ancestry, racial or ethnic identity, or country of origin; these characteristics help distinguish these communities or groups from one another (Zenev & Associates with Alberta Urban Municipalities Association, 2014). For example, eight different dialects of Spanish are spoken around the world: Mexican Spanish is different from Andalusian Spanish which is different from Caribbean Spanish and Latin American Spanish. As multiple Spanish dialects exist, so too are there multiple Hispanic or Latinx identities and cultures (e.g., Mexican, Cuban, Puerto Rican, Guatemalan) (Taylor et al., 2012). While similarities exist among these groups, they each possess unique social and cultural values, norms, and traditions. This example clarifies the need to consider adaptations of EBIs at the deep-structure level particularly for EBIs tested among majority populations but delivered among minority groups.

This small study with a sample from two U.S. states emerged from a larger single state implementation study where evaluators noted that almost half of families being served were receiving ABC in Spanish. The evaluation team, comprised of social work researchers, wanted to understand how implementation might differ for the parent coaches delivering the EBI to these families. At the time of this study, no clinical guidelines existed regarding how to adapt the ABC curriculum among ethnocultural communities while continuing to maintain fidelity. This is concerning since the intervention must be delivered by ABC parent coaches in the parent’s language, not through an interpreter; and, as discussed later, direct English to Spanish translation is challenging. Since this exploratory study was completed, ABC developers have engaged in the following surface-level adaptations: (1) intervention materials have been translated or are being translated to Spanish, including materials provided to parents; (2) first language Spanish speakers are now employed for training and supervision of bilingual parent coaches; and (3) a training to discuss cultural and language issues has been developed specifically for coaches implementing ABC with Spanish-speaking families. Findings from this study were shared with intervention developers, but the researchers do not know to what degree these findings informed the adaptations. At the time of this publication, ABC had not undergone deep-structure adaptations.

Background

This brief qualitative study is part of a multifaceted, multi-year, mixed methods evaluation of ABC in the Midwest which began in May 2017. The purpose of this evaluation was to test the replicability and efficacy of the ABC intervention when integrated into the service array of early childhood home visiting programs across diverse community contexts. Five agencies offering early childhood home visiting programs across Kansas participated in the evaluation which occurred from May 2017 to May 2020. When implementing an EBI in new contexts and with different populations, evaluation of not only outcomes but also implementation processes become necessary. The single state evaluation incorporates both implementation and outcomes evaluations.

To frame the implementation evaluation, we apply the Consolidated Framework for Implementation Research (Damschroder et al., 2009) which provides five broad constructs with associated sub-items that can be assessed during implementation (see Fig. 1). These constructs are: intervention characteristics, characteristics of individuals involved, inner settings, outer setting, and process. The Consolidated Framework for Implementation Research (CFIR) provides a framework for systematically identifying, assessing, and addressing potential barriers and facilitators for effective implementation of an intervention. Using these constructs as a guide, an examination of implementation can lead to insights about what has worked well and what has not, which can guide future implementation and sustainability efforts. Given the breadth of constructs included in the CFIR, specific constructs and sub-items were explored using different aspects or sub-investigations within the comprehensive evaluation. For example, the exploratory study described in this paper centers on the intervention and its delivery, and so it is explored and interpreted through the following three CFIR constructs: intervention characteristics, individual characteristics, and process.

Fig. 1
figure 1

The Consolidated Framework for Implementation Research applied to ABC early childhood initiative

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Qualitative data were collected at various timepoints from project partners to include parent coaches, site supervisors, as well as members of the funding collaborative. Figure 2 details activities completed during each year of the initiative.

Fig. 2
figure 2

ABC early childhood initiative implementation evaluation activities

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Each of these activities provided valuable insights about implementation that could be assessed through the CFIR constructs described in Fig. 1.

In addition to the implementation evaluation, an outcomes evaluation, which included both quantitative and qualitative components, also was conducted. Numerous quantitative measures were collected from participating families and parent coaches pre and post-intervention to assess change in child, parent/caregiver, and family well-being. Measures include the Ages and Stages Questionnaire-Social and Emotional Scale (Squires et al., 2015); Maternal Self-Efficacy Scale (Teti & Gelfand, 1991); Infant Crying Questionnaire (Haltigan et al., 2012); and the North Carolina Functional Assessment Scale (Reed-Ashcraft et al., 2001). Additionally, for a random sample of enrolled families, salivary cortisol samples were collected pre and post-intervention to evaluate change in waking and bedtime cortisol levels, a measure for evaluating toxic stress, among participating children. Toxic stress overstimulates the Hypothalamic Pituitary and Adrenal (HPA) hormone axis which leads to elevated cortisol levels in the body; elevated cortisol, a stress hormone, contributes to inflammation and immunity changes in the brain and body (Johnson et al., 2013). The outcome evaluation found that families who participated in ABC through the project demonstrated more positive outcomes at the child, parent/caregiver, and family levels after completing ABC. These positive outcomes were similar for both families who received ABC in English and families who received ABC in Spanish (Mendenhall et al., 2021).

As mentioned, 50% of the sample identified as Hispanic or Latinx origin. Recognizing the unique opportunity to learn about cultural contexts and implications of implementation directly, parent coaches who were participating in the Midwest evaluation and who were delivering ABC in Spanish were invited to participate in this brief exploratory study. Across five participating sites, three agencies served Spanish-speaking families and employed bilingual parent coaches; two parent coaches agreed to participate. To expand the scope of inquiry and increase the face validity of findings, we invited another agency also delivering ABC to a large sample of Hispanic or Latinx families in the Northeastern U.S. to participate. Two additional parent coaches agreed to be interviewed for this study.

Data collection for this brief qualitative study was completed during year 2 of the ongoing evaluation. Focusing on three CFIR constructs (intervention characteristics, individual characteristics, and process), this paper explores the experiences of bilingual and bicultural parent coaches delivering ABC to Spanish-speaking families and what, if any, challenges were encountered during implementation. The experiences of participating Spanish-speaking families were explored separately and will be discussed in a different paper.

Methods

This brief exploratory study examines the experiences of four bilingual parent coaches implementing the ABC intervention with Spanish-speaking families in two states. Semi-structured interviews were completed with each of the parent coaches serving families across different community contexts; all participants identified as women and are native Spanish-language speakers. Interviews lasted roughly 30 min and were conducted in English by a bilingual and bicultural undergraduate social work student employed as a research assistant on this project. Two participating parent coaches were part of the Midwestern ABC evaluation and two were delivering the ABC intervention in the Northeastern U.S. and not part of the larger implementation evaluation. Utilizing an interview guide which included questions related to intervention and individual characteristics and process, interviews focused on the linguistic aspects of delivering ABC in Spanish as well as perceptions on the cultural relevance of the intervention among Spanish-speaking families. Institutional Review Board approval was obtained for this study separate from the approvals obtained for the multi-year implementation evaluation. This study also was conducted in accordance with the ethical standards outlined for research involving human subjects.

Data Analysis

Interviews were transcribed verbatim by a professional transcription service and analyzed by one researcher, who was not involved in conducting the interviews, using thematic analysis (Braun & Clarke, 2006). Thematic analysis is an analytic method that allows the researcher(s) “to see and make sense of collective or shared meanings and experiences” across a data set (Braun & Clark, 2012). In accordance with the steps laid out by Braun and Clarke (2006), first the researcher read through the transcripts to establish familiarity. During this process, the researcher noted potential codes. During the next stage, the researcher engaged in a process of coding segments of text to describe the concepts, processes, and phenomena shared by participants. Following, a list of initial codes was generated and the researcher coded data with these codes while remaining flexible to emerging codes. After this process, codes were organized into themes. Themes and sub-themes were defined and a final round of coding was completed. The coding process was not based on CFIR concepts but rather post-hoc mapping onto the CFIR framework occurred to improve understanding of implementation implications.

Findings

Analyses resulted in six initial themes organized into two broad categories: (1) challenges to providing ABC to Spanish-speaking families and (2) positive experiences providing ABC to Spanish-speaking families. Challenges to providing ABC centered on intervention characteristics and process, while positive experiences also related to intervention characteristics but additionally focused on individual characteristics.

Challenges

Participants identified four primary challenges which related to intervention characteristics and process: (1) need for translated materials, (2) varied cultural definitions of core constructs, (3) structural concerns and (4) culturally-specific training needs.

Need for Translated Materials

One of the biggest challenges to providing ABC to Spanish-speaking families was the need for materials translated into Spanish. One parent coach said, “Having the manual in Spanish would have been helpful…because I’ve had to kind of read through the English manual and when…writing my notes for the sessions, I was also translating what I was learning into Spanish” (Case 170,526). Some aspects of ABC are scripted and developers emphasize adherence to the way the materials are presented. One participant shared, “ABC has to be used the way they say it…it has to be said exactly how they have it” (Case 170,412). Another participant shared “there was no leeway…you have to say the exact term” (Case 180,215). For these participants, something was always going to be lost in the translation.

Parent coaches frequently discussed translating materials themselves, in the field. Talking about intervention materials used by parent coaches during family visits, one parent coach shared “the videos we watch are in English…so they’re listening to the parents on the videos and I’m telling them in Spanish piece by piece…I think if the video was in Spanish, they would understand it a bit more” (Case 170,412). Although one coach indicated having a Spanish manual was helpful, all other parent coaches shared that the rigidity and academic language involved in the ABC program made the required in-the-field translation into accessible Spanish terms challenging. Parent coaches also described how translation varied by dialect and country of origin of families making some translations more challenging. One coach shared:

What I tend to do is read the English manual and then take all of the main points and translate how I would say it to the family…the direct English to Spanish translation of ABC isn’t very effective, because I feel things get lost in translation…you have to be able to cater to different dialects (Case 180215).

This participant also felt the formality of ABC materials was different from how Spanish speakers traditionally speak in the home. They said:

It brings like an air of arrogance into the home, which I don’t like because then I can’t really get down in the nitty gritty with the parent as I usually would. There’s like a separation that I feel whenever I’m with a parent that is Spanish speaking…and it makes it harder for me to be able to translate it (Case 180,215).

Varied Cultural Definitions of Core Constructs

The second challenging aspect of delivering ABC to Spanish-speaking families was that there are varied cultural definitions of concepts relevant to ABC. Nurturance, a core construct of ABC, focuses on helping caregivers interpret and better understand their child’s behavior signals; lessons aim to teach caregivers to respond in a nurturing way even when it does not come naturally. Parent coaches discussed how the concept of nurturance is culture-dependent and not always consistent with the ABC definition. One participant said: “The families, when I tell them you have to be nurturing to your child…I think that even though we tell them, they have a different understanding of what nurturing is than what we’re explaining to them” (Case 170,412).

Another participant shared, “the first two sessions we focus on nurturance and I realized even growing up and now in this field of work—that looks very different to many people” (Case 180,314).

Some participants suggested that ABC lessons may actually challenge family culture. One coach described how examples used within different sessions may not be culturally relevant; they said:

The examples that are presented in the manual…I am a Spanish individual…I like to put my experiences into it aside from what’s actually being presented in the manual because that brings in a lot more culture…connecting it all together (Case 180,314).

This parent coach shared the need to change examples for intervention constructs to more closely align with the needs and cultures of participating families.

Structural Concerns

Parent coaches receive intensive training and supervision from the EBI developers which emphasizes attentiveness to the ABC curriculum during each one-hour family session; discussion of other topics or emerging needs must occur outside the ABC session. This guidance is intended to ensure the core content of the program targeting specific parenting skills is delivered as intended and that the agenda is not diverted by other needs. The time-limited nature of ABC presented challenges because parent coaches felt they did not always have time to both cover the intervention content and allow families to talk and share. One parent coach explained: “Especially with the Spanish-speaking families, they are very open and they love dialogue…at times it becomes difficult to reel them back in to the focus of what we’re talking about instead of like chit chat” (Case 180,314).

Another participant struggled with the emphasis on ABC at the exclusion of other needs. They shared:

Sometimes it gets too…laser-focused where we can miss some other areas…I think when we focus only on ABC, then we’re not really helping them…you know, because a lot of the families are in poverty…yes, we are there to help uplift them and everything, but…it should go hand and hand to connect them with other resources as well (Case 180,215).

This parent coach felt that addressing families’ other needs also was important; they saw a relationship between food or housing insecurity, for example, and the ability to be fully present and engaged as a parent. For them, pairing resources with delivery of the intervention could only enhance parent–child attachments.

Culturally-Specific Training Needs

Participants described additional training and supervision needs including a need for a dedicated bilingual ABC supervisor or trainer on the model purveyor’s team to supervise and support Spanish ABC implementation, fidelity monitoring, and certification. One coach said:

I think what would have been helpful to me is letting me know that when we do [fidelity] coding [of model components evident in a session recording], they don’t have supervisors in Spanish…So, whenever we had our clinical supervision, my videos had to be translated…so you always lose something in that aspect (Case 170,412).

Part of ABC’s intensive training and supervision with parent coaches involves weekly review, with ABC consultants, of recorded sessions of parent–child interactions. These supervision sessions aim to increase clinical skills and In The Moment (ITM) commenting as well as assure fidelity to the ABC model. ITM commenting is an approach used by ABC parent coaches to draw attention to behaviors parents engage in that are known to enhance secure attachment. Parent coaches are expected to make ITM comments at least once per minute during the home visiting session. Bilingual parent coaches shared they were not only translating materials for participating families on the front end but also the ABC consultants who provided general clinical supervision ITM commenting supervision to them on the back end. This meant that parent coaches were spending valuable supervision time translating video recordings for their ABC supervisors instead of analyzing a specific session or problem solving with them for the next one. One parent coach shared:

It would be very helpful in having someone who can…who knows the language and is able to see the videos and be like ‘Oh, I knew exactly what that meant’…and we can focus more time, on you know, what would be the solution for the next session…the translating part takes a lot more time than actually analyzing what you’re gonna do for the next one (Case 180,314).

This parent coach later described the challenge of having supervision with an ABC supervisor who did not speak Spanish: “When it comes to the Spanish model there is a language barrier…It would be very beneficial to have one bilingual supervisor that can understand the material” (Case 180,314).

Throughout the 12-month training and certification process, parent coaches are expected to meet with these ABC supervisors in two separate meetings per week to review individual cases and receive feedback. Between preparation for supervision and the meetings themselves, parent coaches could expect to spend approximately four hours per week for supervision. The expectations and time commitment were greater for bilingual parent coaches than for those delivering the intervention in English only. Translating materials both forwards and backwards resulted in additional labor for the bilingual coaches that they were not initially expecting. It also eroded the time and attention they received in supervision potentially limiting their skill mastery or development; their monolingual peers were more fortunate.

Positive Experiences

Two positive themes, relating to intervention characteristics and individual characteristics, emerged regarding delivery of the ABC intervention specifically among Spanish-speaking families: (1) perceived cultural relevance; and (2) worker qualities or characteristics that enabled work with Spanish-speaking families.

Cultural Relevance

In contrast to the challenge discussed earlier about varied cultural definitions of core constructs, even across different Spanish-speaking communities, some participants believe other specific aspects of ABC, as designed, are in fact culturally relevant to families. Specifically, participants discussed familial unity and virtues of behavior as being culturally relevant to families of Hispanic and Latinx origin. Parent coaches believe that the ABC program leverages concepts of unity and behavior through such activities as play or reading which helps strengthen the parent–child bond, thereby enhancing family unity This is a strength according to the bilingual, bicultural parent coaches. One participant connected this idea specifically to the prioritization of family within Hispanic cultural norms and values:

The Hispanic culture is based on wanting to make sure that their relationship with their children is there…I think that this ABC program builds on that and helps…to find different ways to help them see that…playing with your child…reading a book is important…their main cultural thing is building a family, a unity, and I think [ABC] helps (Case 170412).

Worker Qualities or Characteristics

Finally, workers described aspects of themselves that they perceived as promoting a positive experience with Spanish-speaking families receiving the ABC intervention. These characteristics specifically related to similarities between worker and families. Receiving services from someone with a similar cultural background who were also native Spanish speakers and possessed knowledge of the diversity of Spanish-speaking communities allowed ABC parent coaches to more easily join with the family.

One worker explained why having a native speaker as a parent coach for Spanish-speaking families would be helpful:

I think it helps because, in a way, the Hispanic families seem to, I guess, find more comfort because they know that ‘oh you know how things are!’ Our culture might be different…but we still have that, some of that root…which is hard for people to learn in school…you learn the language, but you don’t learn the culture of understanding of it (Case 170412).

Another coach explained “once they notice I start talking Spanish, you can tell…their shoulders are relaxed. They’re like ‘Oh you’re speaking Spanish!’ Now there’s a comfort level that wasn’t there two seconds ago” (Case 180,314).

Parent coaches believed their bilingual, bicultural identities assisted them in building stronger rapport with families which supported uptake of intervention content.

Discussion

Bilingual home visitors are good, culturally tailored interventions are better. Deep-structure adaptations of EBIs can help create culturally tailored interventions for use among different ethnocultural groups. Deep-structure adaptations “address core values, beliefs, norms, and worldviews” of a particular ethnocultural population or group (Wang-Schweig et al., 2014). Utilizing the Consolidated Framework for Implementation Research (Damschroder et al., 2009), we identified three implementation constructs where opportunities exist for deep-structure adaptation of ABC: (1) intervention characteristics, (2) characteristics of individuals, and (3) process.

Despite practical service delivery challenges related to translation and supervision, the family focus appears to be culturally aligned with some Spanish-speaking populations.

Though these results are limited and exploratory in scope, they demonstrate the potential value of engaging in work to specifically adapt this program at the deep-structure level to meet the unique needs of Spanish-speaking families. Beyond offering a Spanish manual, the model purveyors of ABC might develop case examples of core constructs that more closely align with Hispanic and Latinx cultural values and norms such as familial unity. At the same time, developers might consider translating ABC materials into more accessible, less academic vernacular to foster deeper connection and engagement with curriculum content. These two suggestions could potentially resolve the concerns identified in Intervention Characteristics, one of the CFIR implementation constructs. If the ABC curriculum cannot be adapted at the deep-structure level, additional supports are needed to help parent coaches identify (1) when precise definitions of ABC constructs must be maintained, and (2) how best to align varied cultural definitions when change is indicated, while maintaining program integrity.

Another example of a deep-structure adaptation might involve review and refinement of intervention structures. While maintaining structure and program integrity is a central and worthy goal, it must be balanced with cultural norms to ensure program fit or appropriateness, increasing the likelihood of content uptake and application by participants (Blanchard & Livet, 2020; Proctor et al., 2011). Creating opportunity for families and parent coaches to incorporate the unique cultural norms and traditions of participating families is one example of a deep-structure adaptation that could enhance cultural responsivity. Beyond incorporating unique cultural norms and traditions, building additional time into the one-hour sessions to allow parent coaches the opportunity to address other, emerging needs is another deep-structure adaptation to consider. As one parent coach highlighted, many of the families are impoverished. Poverty and other concerns complicate their lives in ways that may impact their ability to parent in sensitized ways, let alone fully engage with intervention content. This opportunity addresses challenges identified in the CFIR Process construct.

Since this study was undertaken, bilingual parent coaches can now receive bilingual clinical and ITM supervision. Parent coaches identified additional labor preparing for supervision and reduced guidance and support during supervision meetings. Changing the environment in which supervision is provided offers an opportunity to evaluate its impact on parent coaches’ behavior, confidence, and competencies as well as fidelity. This adaptation would address challenges raised by participants and address two CFIR constructs: intervention characteristics and characteristics of individuals.

Implications for Practice and Future Research

How an intervention is delivered and implemented is as important as the intervention itself. The information gleaned from this exploratory study, as well as the larger single state implementation evaluation in which it is embedded, help close the gap between implementation research and clinical practice. Implementation efforts must be individualized and responsive to the cultural norms, values, and rituals of a local community. From an eco-developmental model, issues such as gender, socioeconomic status, religion and attendant community factors can inhibit or facilitate outcomes or intervention effects; deep-structure adaptations may help address these concerns across all communities. Additional research is needed to explore the processes by which ABC and other EBIs are adapted at the deep-structure level to gauge impacts on engagement, fidelity, intervention outcomes, and ecological validity. Beyond this, who delivers the intervention and how also can inhibit or facilitate outcomes. Future research should explore individual characteristics of providers as well as the supportive structures offered them to assess impact on provider–client engagement and uptake of intervention content.

Limitations

This study has several limitations. The small sample size limits generalization of findings. It also limits the breadth of information about bilingual and bicultural parent coach experiences in translation and delivery of ABC to Spanish-speaking parents or caregivers. Despite these limitations, this exploratory study was useful in assessing the value of proceeding with deep-structure adaptations of ABC to improve the appropriateness and fit among Spanish-speaking populations.

Additionally, methods were limited in multiple ways. First, an audit trail was not kept to support this analysis. An audit trail is a technique used by qualitative researchers to document and describe various theoretical, methodological, and analytical activities and decisions that occur during a research project; audit trails can enhance trustworthiness and confirmability of findings (Thyer, 2001). Further, interview data was coded and analyzed by one researcher. The addition of a second coder might have expanded the understanding and interpretation of our data thereby enhancing clarity and strengthening the analysis (Keene, 2020). Finally, analysis did not include member checking. Sometimes referred to as participant validation, member checking is another strategy used by qualitative researchers to enhance trustworthiness. By inviting participant feedback about data or findings, researchers can check the accuracy of their analysis and whether findings resonate with study participants’ experiences (Patton, 2015). Future studies building on this initial exploration should address these limitations to enhance trustworthiness and dependability of the findings.

Conclusion

Few guidelines exist regarding delivery of EBIs tested among homogenous, majority samples to ethnic, minoritized groups. Given the increasing use of EBIs within ethnocultural communities, this is concerning. As social workers, we recognize the impact of culture on how one perceives their needs, the solutions necessary to resolve them, and the helping relationship. We understand that culture is not static; values, norms, beliefs, and assumptions may change as context(s) change (Erez & Gati, 2004). Further, we recognize the impact of systems and structures (e.g., organizational policy and procedure, intake and assessment, service scheduling, training and supervision, etc.) upon client-provider engagement, retention, and service delivery efficacy and effectiveness. Culturally tailored, multi-faceted approaches can help mitigate these concerns and improve EBI outcomes among service populations.

With respect to our focus on potential deep-structure adaptations of ABC, a culturally tailored, multi-faceted approach might include one or more of the following: (1) exploration of how biopsychosocial and economic factors impact participant engagement, retention, and uptake of ABC among English and non-English speaking families; (2) examination of ABC structures and processes to assess how these shape parent coach behavior, competency, and fidelity to the intervention; (3) examination and refinement of core curriculum to more closely align with the unique cultural values and norms of different ABC service populations and increase accessibility; (4) exploration of the utility of families incorporating their own unique cultural traditions into one or more sessions to enhance cultural responsivity; (5) development and adoption of standards for in the field translation of ABC constructs to better support bilingual parent coaches and assure consistency of messaging, content, and outcomes; and, (6) building time into sessions for parent coaches to respond to the emerging needs that often complicate the lives of at-risk children and families.

Organizing our findings through the lens of an implementation framework like the CFIR (Damschroder et al., 2009) helps illuminate and clarify potential barriers and facilitators to effective implementation of this EBI across different community contexts. As ABC continues to scale up and out to more diverse families and communities, the challenges and potential solutions identified here will warrant further attention to enhance uptake and further strengthen parent–child attachments.